The Royal Elms Care Home

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• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

We looked at 3 quality statements in this domain. Relatives said they had been involved in agreeing the care and support people needed when they moved to The Royal Elms. They said they were kept up to date with any changes in the relative’s health and wellbeing. Staff knew people and their support needs and were kept up to date with any changes in people’s needs through handover meetings. However, care records did not always contain full details of the support strategies staff should use when supporting people. People were supported to maintain their health. The GP visited each week, and this was said to be working well. A visiting professional said appropriate referrals were made by the home and staff were knowledgeable about the people they came to see. They said they had worked with the home to improve the care for 1 person. The home had followed their advice. However, we saw a referral had been made to the speech and language team (SALT) which had not been followed up for 2 months when the home did not receive a response from the SALT. People and relatives said the food was good. People had a choice, and people’s preferences were catered for. A modified diet was provided where people were at risk of choking, although this wasn’t reflected in their care records, We were told 1 person refused to follow a diet recommended by health professionals. This wasn’t clearly recorded in their care file.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Relatives said they were involved in agreeing people’s support needs when they first moved in and had provided the home with information about people's preferences, likes and dislikes. They said they were kept up to date with any changes in their relative’s needs.

Staff told us that they had information about people’s needs and how to support them. They discussed people’s needs and any changes in their support during handovers.

Processes were in place to assess people’s needs prior to admission to the service and risk assessments and care plans were reviewed regularly. However, there was not always enough detail to guide staff to meet these needs. For example, 1 person could become agitated but there was no information on how staff should support them on these occasions. Another person was occasionally non-compliant with care. There was no guidance for staff on what to do in these instances. One person had moved to the home on a temporary basis. However, they had stayed for longer than anticipated but only had a brief ‘short term’ care plan in place rather than a full care plan assessing their support needs. They did not have a personal emergency evacuation plan in place. We were told the person had been due to move to a new home quickly, but this kept getting delayed.

People said they had a choice of food, and the food was good. A relative said the chef had adapted the menu so their relative had more of the meals they liked. Another relative told us their relative had put weight on since moving to the home. A relative said, “They weigh [Name] weekly at the moment and update me. They prefer sweet food, so they are having more puddings; the staff push the food they like.”

Staff knew people’s dietary needs and who needed support when eating. The chef knew who required a modified diet. One person had had a choking incident. Their meals had been changed to a soft option to reduce the risk of further choking issues. A staff member said, “We observe people eating and get to know what they like. We’ll give people extra pudding if we know they like this.”

Care records did not use the current International Dysphagia Diet Standardisation Initiative (IDDSI) framework for identifying any modified diets or fluids people needed to reduce the risk of choking. People’s dietary needs were not always identified in their care records. For example, 1 person had been diagnosed with an auto-immune disease and we found the GP had advised for them to be provided with the correct diet. There was no information available about the foods they should have or avoid. The chef was aware of the diagnosis. Staff told us the person had refused the diet but there was no evidence of this recorded in the individuals care records. Another person was at risk of losing weight. They had been prescribed supplements, but the care plan did not contain details of having a fortified diet. We were told diets were fortified with cream. Some care records contained the RESTORE2 adult physiological observation and escalation chart to assist in identifying if a person’s health was at risk of deterioration. We were told these were used when people’s health may be deteriorating.

We did not look at How staff, teams and services work together during this assessment. The score for this quality statement is based on the previous rating for Effective.

Relatives said they were kept informed in any changes in people’s health and wellbeing. They said medical attention was sought when required, including referrals to specialist teams, for example the falls team. A relative said the home would arrange transport for medical appointments and staff would support people to the appointments if required.

A medical professional said that appropriate referrals were made to them, and staff had the information available they required. We were told there had been some issues around skin care for 1 person. These were discussed with the registered manager and improvements had been made. The GP completed a weekly ward round, which was working well.

Referrals were made to medical professionals when needed. However, a referral to the speech and language team (SALT) had not been followed up for 2 months. Some actions had been taken by the home to reduce the risk of choking, but no formal assessment of their needs had been completed. We were not assured the person was being effectively supported to manage the risk of choking in a timely manner.

We did not look at Monitoring and improving outcomes during this assessment. The score for this quality statement is based on the previous rating for Effective.

We did not look at Consent to care and treatment during this assessment. The score for this quality statement is based on the previous rating for Effective.